Yeah, I'm stressed

I went out to a comedy club last night, and it was awesome. Had a couple of glasses of wine, and I woke up this morning at 6:20 am with a sense of blind panic: what the FU*CK am I going to do, and how am I going to manage to have a baby? I've had all of these fears since the negative test, but never at such an amplified level; alcohol, which is apparently supposed to make you relax, is not so very kind the next day. Another one of biology's decidedly unfunny pranks.

I've had 3 great quality (based on morphology alone) blasts transferred, with no pregnancy, which does not bode well at all. You never know what will happen the next round though.

Coming to India to do this was the decidedly lower tech but cheaper approach. I did not think it would be this low-tech though, I thought when I came here that I would be able to biopsy the embryos, but that option was one my RE was not comfortable with, despite the tools being available. Mind you, I was well aware that this approach would not guarantee success, what it would do would be to provide a basic answer: do I have an issue with aneuploidy, and hence, have to go to donor embryos or adoption to have a baby?

There is another thing I've learned recently, and it is an interesting fact: We assume that if there is aneuploidy, it comes from the egg or sperm (and more often, may be the egg). Turns out that they have done studies which show that in a large number of cases, aneuploidy is introduced during the first few cell divisions of the fertilized embryo. This is why there is mosaicism and a high degree of aneuploidy in the day 3 embryo. As cell divisions progress though, the process appears to become more efficient, which is why some some mosaic embryos may be rescued and may even produce healthy babies.

But the point of all this is: cell culture conditions in your IVF lab may matter. Interestingly, RMA-NJ appears to have a lower rate of anuploidy in their blastocyts (32% as opposed to 50%) from some other groups. Is it something different they do? They are definitely trailblazers and pioneers, because they came up with the CCS technology (no mean feat), so yeah, that is possible.

To see if my own eggs have any kind of shot,  I've decided to go to RMA-NJ if the next few transfers fail. I've been a busy bee this week: I arranged a phone consult with RMA-NJ, I've started looking into jobs in that area, etc. Sadly, arranging employment with a company over 50 employees in the NJ area (which would qualify me for practically free IVFs) is not looking promising, not unless I go back to a university postdoc position. And if I took that, I would have to stick with it for a while. But I don't WANT to be a postdoc again. Sigh.

Btw, the costs for IVF at RMA-NJ with nothing covered comes to around 12,000 dollars plus 5000 for CCS screening. That is the higher end estimate, I could bring it down in many ways if I become eligible for any of their trials (they have a lot of those). Their donor cycles are 43,000 smackeroos. Crazy shit I tell you.

The money, and arranging it all, is giving me stress. So it would be super nice if the universe surprised me with some good luck, with making any of these next transfers work. 

Only one line

You know that moment of utter calm when you receive horrible news? Sadly, it is getting all too familiar now. The surrogate took a home pregnancy test, and it was negative. We'll still do the blood beta a few days later, but this means game over: it is the 13th day of embryonic life today, and unless the test she took was super insensitive, nothing is happening.

With a double blastocyst transfer, the success rate is about 60%. Maybe she has a discriminatory uterus, and those blastocysts were not viable and hence they did not take. This is when I desperately wish to god that I could have been in a setup where they could do the testing to determine which of my 8, if any, are okay, so we would dispense with the expenses of multiple embryo transfers and the emotional toll of all this.

I've known the transient joy of BFPs. There is a part of me that wants to run out there and get an IUI done so I have a chance of seeing those 2 lines again. But that is foolhardy; I know that despite my fear of  pregnancy, I am willing to get pregnant again, but it will only be with an embryo that I know is euploid, so I don't have to risk putting my body through the wringer again.

One of the women who used my donor sent me a picture of her son yesterday. He is so adorable, and looking at him, I so badly wanted one of my own. God knows how long I have to wait.

You know, with all of this, the one thing you need is luck. I'm had the most horrible luck so far, and I don't know how or what I can do to get it to change.

I have one question: I'm really thinking about moving back to the States ASAP now (I'm kind of afraid that none of my 8 will work, so once the transfers are done there is nothing holding me back here). Has anybody ever been able to get IVF covered in NJ, while being self-insured?

A life stuck at "pause"

It has been almost a year since I got back to India, and I think it is getting to me. This post unleashes a very long suppressed rant on life in India.  It is frickin hard living here, if you knew and enjoyed a rather radically different sort of life. Being with my family is great, my life is super comfortable, I don't have to brave the icky public transport or the dirty streets, and I'm pampered and cosseted. But I'd so much rather be doing my own laundry, cooking my own food at the end of a long day, and slugging it out all around. My social life is pathetic; I've made friends this past year, but people are so spread out, and getting from point A to point B takes hours and is such an exercise in frustration that plans often fall through.Most of the time you are so exhausted that you give up and stay home. I can't wear the clothes I want to wear: its been MONTHS since my legs were exposed to daylight, I'm so sick of skinny jeans I could scream.

I have not dated, heck I have not even flirted with anybody in over a year now (the Indian guy I was speaking to for months helped take the edge off ).  There are no interesting men around anyway, and even if there were, dating here is like speaking in a foreign language.There is this younger  (like 10 years younger) guy at work and he is constantly asking me out to things, and I always try to make it a group activity because I don't want to go out with him alone and have him get the wrong idea. Indian guys do tend to take rejection more personally. Its So Bloody Complicated  here, ugh.

And then there is rest of the reality of India. This is a country that has a few amazing and unique things going for it (mainly due to the fascinating people who lived around around 2000+ years ago).  But the India of today? It is overpopulated, over-obsessed with religion, dirty as hell, repressed, inefficient, illogical, and insane in so many ways. The traffic is a nightmare, and its made worse by many acts of utter ludicrousness; in the most crowded streets that are always clogged, cars, cycles and bikes are illegally double parked, and nobody does anything about it. I once spent 5 hours in traffic in the course of a day, getting from one point to the other within the same city. During religious festivals, people play music on loudspeakers and its so loud that your windows reverberate. This goes on for hours and lasts till past midnight. You can't call the police on them because the police may be out there dancing with them, and heck you can do anything, but you can't interfere with anything religious.  I never get to walk anywhere because everything is so icky, especially in the rains. I really miss New York in that regard.

Basically, I live my life at a state of low level frustration because of all of this stuff and because I'm  missing my life back there. I thought I'd be raising a kid through it, which would highlight the good stuff (being back with family, letting my parents letting to know their grandchild, but that is so far away and I don't know when that will ever get here. So I'm stuck in a painful pause, and I feel like my life could start moving again if one of two things happened: a) I got on the road to baby-making or b) I got out of here.

My job is one of the good things: this is a great company that is based worldwide, and it gives me an opening into a career which would make life as a single mom very easy. So I have to stick it out here for a while because of the job, and because I'm waiting for stuff to happen.

Speaking of stuff happening: I've mailed HPTs to my surrogate; I'm waiting for her to get it so she can do a home pregnancy test, which I will have to talk her through.  Like I've said, the verdict has already posted (it would be the 12th day of embryonic life today, and in each pregnancy, I've known by the morning of day 10), but I just have to wait to get hold of that envelope.  

I worked up my courage and asked my surrogate if she "felt" anything. She said she felt like it may have worked because her "stomach felt heavy." She has been pregnant a few times so its possible she may "know,"" or its just probably the progesterone effects. But bless her for saying it...It cheered me up a little at a time when I badly needed cheering up.

On a completely different note: I've saw this study from RMA-NJ; most studies report a general blastocyst aneuploidy rate of around 40-50% but they reported 32%. That is fascinating- was it a one-off thing or do they make better embryos that other clinics? That is definitely possible, I've realized; you can make many little choices which CAN improve embryo quality. I then remembered that NJ is the one of the few states that mandates IVF coverage, which made me make an important decision today: If none of my 8 embryos take, I'm going to have to go get a job in NJ and live there for a while so my IVF costs will be covered (Yes, I may be willing to put myself through this shit again). Not a fan of NJ, but the good news is, after Mumbai, the garden state looks awesome.

I've sounded like a sulky shallow(guilty!) child for most of this post, and I apologize if I have offended anybody reading. There are many good things about being in India too, even sans baby and the silly things like a lack of good-looking men and the freedom to wear shorts:  Its mostly my family, which is incredible beyond words, but there are some other things too: good food, some genuinely kind people, some really great cheap services that include affordable permanent hair removal. I'll never have to wax again. THAT is pretty goddamned awesome.

On the discriminatory uterus

I'm (or rather my surrogate is) now 5 days into the 2-week wait, which technically should be the 9-day wait, considering that we transferred 5-day-old embryos. It all now comes down the embryo versus the uterus. A lot of REs just brush aside  the uterus in this process, choosing to believe that implantation and events beyond lie depend on embryo quality. But its a pas de deux, with the outcome depending on both players. You could have a hostile uterus that could impede implantation. Or you could have an overly friendly uterus that implants any and all comers, like mine. There is now a whole school of thought supporting that it is the latter that is often responsible for recurrent pregnancy loss. I don't have issues believing this; I've noticed that there is a subset within the RPL group who get pregnant extremely easily, at a rate far above the 20% average per cycle.  I think the only thing perplexing me is that there are many people who do not have an issue with recurrent miscarriage, but get pregnant just as easily. One could argue that the difference is that the RPL folks are also more prone to aneuploidy,which may be the key.

So what the sensible part of me is hoping for, is that my surrogate's uterus is the discriminatory kind, is such a thing indeed exists. The part of me that is all about instant gratification just wants a BFP, and will worry about the next step later. I've both been grateful, and sorry for the fact that my aneuploid embryos implanted in me. I'm grateful because although these were traumatic experiences, they strengthened and changed me in the way that 3 BFNs would never have been able to. They made me pursue avenues of investigation that I think improved my overall health and well being (thanks to supplementation). I look at photos of myself before I started, and myself now, and know I look much better than I did when I was 30; Vitamin D improved my skin and I put on a few badly needed pounds after taking it. I'm sick less often; infections that get everybody around me pass me by.  Myo-inositol has made my skin look better, and it (along with vitamin D) are supplements I plan to be on for the rest of my life, irrespective of whether I am trying for a baby or not.

But I've also paid for it;  had I had only BFNs and not miscarriages, I would not be a woman with a past. If I meet somebody now (like the guy I *almost* got engaged to), I'm obliged to tell them about my losses because I have had 3 so far and its something that they should know if they are planning to have babies with me down the line. Unfortunately, such news is a deal breaker in many instances, especially if the person is just getting to know you. But springing it on them later is also inherently risky, so its a catch-22 situation.

Nonetheless, I may not have a discriminatory uterus, and this has changed my life forever, both for the better and for the worse. Here is hoping my surrogate has one...

I have 8 blasties, 2 of which are now in the running to possibly become the focal point(s) of my existence. Despite the pretty decent looking odds, I'm not optimistic. Hopeful yes, but not optimistic. But I'm really glad that hope is around. Poor girl (don't know why everybody decides she is female), she gets crushed so often, but keeps rising up after. Here is to her!

A commentary on the practice of medicine and what lies ahead.

One of the worst things that I realize I do during the TTC process is become too immersed in it. When I was trying to get pregnant, I would google and run pubmed searches till I could practically recite the study results; I chased down every possibility I could think of, and I thought of a lot.Some of that paid off though. I just wish I had done less of it.

The same issues are starting to rear their heads back again now. I've examined practically every study that compares IVF protocols and have obsessively examined those that look at  blastocyst aneuploidy and quality.But anyway, I think I've learned a lot, and I'll be updating both the science of infertility page, and creating a new section on IVF. 

I was talking with my RE's wife (also an RE; a really sweet lady who did my retrieval) about how well this cycle worked out and I commented that a lot of it might have been due to the protocol I tailored for myself (I also tweaked it on the fly) and she joked that I should consult for the more difficult cases, and I quipped back that I would, if I got paid for it. But there is an important take home message here: even among a group of patients labeled "infertile," there are subsets with unique issues. Recognizing those issues, tailoring each protocol individually, being invested in the tiny details, and making changes based on those details as the treatment proceeds may be what is required to optimize your treatment.

As an example, I decided to check LH levels during my treatment (my RE only checks E2). Everybody responds different to both the agonist or the antagonist. I realized that with the antagonist, my LH was getting too suppressed, my E2 was not rising as it should have been (E2 production DOES require LH), and the follicles on the right were lagging (13 mm, as opposed to 19 mm on my left).  I decided to add back LH (in the form of menagon) on the last day of stims. We did not check E2 or follicle growth after that, but the results on egg retrieval day were fabulous; my right ovary had caught up and made even more mature eggs than my left. Was the situation helped by the low-dose LH add back? Impossible to say, but plausible.

Unfortunately, few take such a detail-oriented approach, or have the sort of attitude necessary for such an approach. While patients of a particular disease type fall into into subsets, medical treatments today use a broad strokes approach; the same freaking approach is used to treat everybody who comes your way. I have rarely ever met a doctor who is maverick and intuitive and adjusts the protocol (ANY treatment protocol) on the fly. It takes a rare sort of personality to do that. What REs do when you do not respond (which is the club-on-the-head approach of pushing the stim dose up higher and higher) does not count.

The only doctor I've come in contact with who is truly intuitive and maverick and can to an extent accurately delineate between the shades of grey of human biology is my mother, and the sort of intuitiveness about what is the issue and what may work that she has is extremely uncommon. Her results speak for themselves; she is in a field where the doctors end up doing very little to help their patients, while her methods produce a near to full recovery in a pretty high percentage of her patients. 

Btw, when she was giving me sub-cutaneous injections, we discovered something nifty: Instead of squeezing a wad of skin for sub-cut injections, try stretching the skin out with your fingers; I did not even feel the needle go in. The few times I got the traditional grab-fatty-skin-and-plunge-needle-into-the-pinched-up-wad-of-skin approach (from the nurses at the clinic), it hurt way more.  

Anyway, I digress. Coming back to medical approach and its effect on the success rate, there are some IVF clinics in the world that may show a level of success that surpasses that of their peers, and one of them is CCRM. I visited their webpage for the first time the other day, and I was impressed. Forget about protocol optimization (but please, blog visitors, feel free to talk about your experience with respect to this, it would be very useful), they use an embryoscope that minutely tracks the growth of each embryo, they do PGD, and they freeze their embies one per vial (they have to, if they are doing PGD)...I was practically salivating. But god knows, I don't want to go through another IVF or pregnancy again. Anyway, the time of reckoning is coming up quickly. Transfer to the surrogate occurs on Tuesday.

Then begins an interminably long wait: my RE's clinic believes in testing 12 days after a 5-day blastocyst transfer, which does not seem logical. It would make sense if you were doing a 3-day cleavage embryo transfer (because then you would be testing on the 15th day of embryonic life), but it just prolongs the wait (and the torture) if you want to wait until the 17th day of embryonic life. And given that in every pregnancy (even the one with the Trisomy 4 blastocyst), I had a positive HPT by the 10th day of embryonic life, my RE's assertion that "testing 10 days after 5-day transfer may be too early" cannot be taken seriously. Let us see how putting my foot down goes. But here we go again, soon.

Dont. Ever. Assume. Anything.

This is the age where many clinics are moving towards single blastocyst transfer, to avoid the risk of multiples, because bad things can happen even in a twin pregnancy. It is the sensible thing to do, and many people have started to do it. I've clearly told my doctor multiple times that I specifically thought a double blastocyst transfer was a bad idea, and that I wanted to transfer one at a time.

I assumed, stupidly, that my clinic would follow the practice of  freezing one blast/vial. I had a rude awakening today...everything is frozen in pairs. I could have prevented this if I figured this is what they would do, but I assumed that they would freeze single blasts.

Now, I'll have to transfer 2 blasts to my surrogate, or refreeze one (for obvious reasons, I hate this idea). There is so much potential for everything going right, but there is also more potential for things going wrong, and if so, maybe even catastrophically. I've seen enough things go wrong with women with twins on these blogs to know exactly how catastrophically.

And even if most things go right, twins come early. This is a country where the neonatal care is primitive compared to that in the west. I really wanted any child I might be lucky enough to have to be born full term. To be born through a natural delivery, not a C-section.

And now, these options may be gone. And I could have prevented this, had I not assumed things.

Huge sigh, and some tears too. 

A tale of 2 ovaries, surrogacy, and the pitfalls of day 3 transfers

I've become aware, over my TTC journey so far, that my 2 ovaries may behave differently with respect to egg production. I think all 3 of my pregnancies (not sure about the first) came from eggs from my left ovary. The one time I had a BFN was when my right ovary was in play.  This IVF, when it became clear that my right ovary follicles were smaller than my left, I asked the embryologist to keep track of the eggs from the right and left. At egg collection and fertilization, it seemed, surprisingly, that the right did better than the left.But.....as things progressed,things changed.

Right Ovary Day 1 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN 2PN Day 2 4A 4A 4A 4A  4A 4B 4C 4C no data provided Day 3 8A 8A 8A 8A 8A 6C 6C 4B 2A Day 4 early blast early blast early blast morula morula 8C/B 8C/C fail fail Day 5 4AA 4AA 3AA early blast early blast fail fail fail fail Day 6 frozen  frozen frozen poor  blast poor  blast fail fail fail fail
Left Ovary Day 1 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN 2 PN Day 2 4A 4A 4A 4B 4C 4C 2A Day 3 8A 8A 8A 8A 6C 6C 5A Day 4 Early blast Early blast morula 10 C/A comp 8 C/B 8C/B 5A Day 5 4AA 4AA 4AA 2AA 1AA fail  fail Day 6 frozen frozen frozen frozen frozen fail  fail
If you plot the fate of each embryo to figure out where the blasts came from, its amazing how much better my left is than my right. I still can't understand why the mojo appears to be in the left and not in the right (70 % of my fertilized eggs from the left made it, as opposed to around 37% from my right). I'm sure such a dichotomy may also exist in other people, it may just be difficult to spot. Another point I want to emphasize...sometimes the embryo you think has no chance on day 3 CAN actually make it to blastocyst, like my 6C  Day 3 embryo that became my 1AA blastocyst. I was reading a post from a lab who only does day 5 transfers and  the doctor commented on how often they are surprised by poor quality day 3 embryos actually go on to become Day 5 or Day 6 blasts and produce healthy children.  I think a lot of people look at poor quality day 3 embryos and think that they may be saved if they go into the uterus and are certain that, if they wait till Day 5, they will end up with nothing. But I think a little faith is needed, because from all scientific and anecdotal accounts, that location seems to make no difference. Embryo cell culture is something that HAS been optimized, then tried and tested by many labs around the world. And while the uterus is a great place to be, there is definitely a body of studies that show that in a subset of women, the uterus may itself contain hostile factors. Basically, its a level playing field if you are comparing the petri dish to a uterus. If a day 3 embryo has the developmental potential to go the distance,  it will,  no matter where it is. And if it won't, it won't. And this part is just pure idle speculation but I would think, technically,that a day 5 embryo may be able to hold its own better against the hostile uterus a touch better than a day 3 embryo...I'm saying this because a day 5 embryo would make more HCG, a hormone known to cause immune cell apoptosis, and possibly other factors that aid in implantation. The issue with day 3 transfers (in addition to all the risks associated with multiples) that I see is that it puts you through a so much longer period of uncertainty- if none of the embryos will make it, it is actually easier on you to find that out after a phone call from your doctor, as opposed to going through a transfer, a 2WW, paying (monetarily and physically) for your progesterone, your blood test, all of it. Importantly, if your Day 3 embryo transfer fails, you remain in the dark as to what the issue was: was it embryo quality, or implantation issues? On the other hand, if a blastocyst transfer fails repeatedly, its a little bit more likely that the issue may lie in uterine receptivity or immune-related causes. Anyway, moving away from preaching (I am sorry to be doing so much of it; I just can't bring myself to stop), my new surrogate is going through the preparations for transfer. I don't have a transfer date yet, but I HAVE decided to  be brave and only transfer 1 blast.  The last time I picked a surrogate, I was hoping it would be somebody I was comfortable with. Now, I'm finding myself desensitized and starting to treat this the way surrogacy in India is meant to be treated: emotions should be left at the door. Obviously, this is a deeply different process compared to say, the one in the States. As a point I am thankful for, this is not her first rodeo, so to speak; this is the second time she is attempting surrogacy. The first time, she got pregnant on the first shot and had a natural delivery. With so much possibility (in terms of embryo availability), I'm still not tempted to try to carry the baby myself. When I first got pregnant, and heck, even the second time, pregnancy was joyous. Now, the thought of getting pregnant, finding myself at the mercy of hormonal upheaval, of getting 50,000 blood tests and waking up 4 times a night--- I just don't want any of it. I know how much good stuff I am going to miss out on and I still don't want to do it. If my eggs don't work and adoption does not seem easy either, then I may have to go through donor embryo IVF (with PGS) in the States, and that thought makes my blood run cold---just because I'll have to go through pregnancy myself. I am aware that I am missing out on an incredible and important life experience  by choosing to avoid pregnancy---but I remain comfortably numb about it all.

IVF#2: the postmortem and the spewing of many opinions

First, my last 2 blastocysts (which we hoped to freeze on day 6) did not look good, so they did not freeze them. It is so awesome that I was able to respond to this news with a shrug. I'm just so grateful things have gone well so far. Final tally: 8 blastocysts frozen, 5 of which are the best grade my clinic assigns.

The aftermath of the retrieval was ugly though. I had bad OHSS. I  went 3 days without eating; I was so bloated and was ridiculously weak, really no picnic. I have to salute the women who queue up for an embryo transfer when they are feeling like that.

Anyway, here are some of the factors that I felt may have made the difference between this cycle and the last.

•  My physiological state: Inexplicably, after my vitamin D levels went really high, I feel I fell into a reproductive slump: one failed IUI cycle, a pregnancy with my first autosomal trisomy (bad news), and then that disastrous IVF. As I tapered down my supplementation (from 5000 IU to 2000) IU/day), things did change, but slowly. The most noticeable change was a change of my natural ovulation day (day 17 during the slump period), now moved back to day 20/21.
• A more natural IVF cycle: The first IVF, LH was very high around day 2 (because when you first give the agonist, it first triggers a burst of LH production, and then the pituitary shuts down) and the LH (300 IU /day)  because of the menagon. This is the exact opposite of what my natural cycles look like. So I picked a cycle that was much closer to my natural cycle: lowish LH throughout, except at the time of the surge, mild FSH stims (only 150 IU/day, as opposed to a staggering 450 IU/day the last cycle).  
• 1000 mg/day myo-inositol: This one is supposed to help in increasing the proportion of mature oocytes at retrieval in women with PCOS: this is exactly what happened with this cycle, mad coincidence or not. In non-PCOS women this effect has not been observed, but it does help improve implantation slightly. Btw, any women with PCOS considering myo-inositol should read this: the effect of a combination of myo-inositol and D-chiro inositol.  From my own experience, I think I can now vouch for myo-inositol (1000 mg/day).

Now, for the opinions.

I've spent the last few days just thinking about some of the standard practices in IVF clinics, and a lot of them just seem logically flawed in certain ways.

1) High dose Menagon/menopur use, which gives you as much LH as it does FSH. My RE remarked during my cycle that many clinics like to keep blood LH levels  below 2 ng/mL. How many people do a LH blood test while taking 300 IU/day menagon? What would the blood level would be at? I'd say its a fair bet that it would be above 2: do you need that? No. Can it be detrimental to embryo quality? Maybe.

2) Use of higher dose stims so you can increase the egg yield: Multiple studies have shown that if you up your dose of stimulation (from a mere 150 to 225 IU/day), the aneuploidy rate also goes up...from 40% to 70%. The issue is, both the doctor and patient just want the illusion of security provided by many follicles on the ultrasound and a high egg yield . It makes the cycle look good on paper, if say, you get a total of 20 eggs versus 10.

If you can get 10 embryos (with only 3 of them actually being good quality, but you don't have the technology to figure that out), or only 3 embryos that are much more likely better quality, which one should you pick? Sadly, everybody goes for the approach that maximizes quantity, because that is a tangible,albeit potentially misleading measure, as opposed to quality, which is something which is difficult to assess.

This approach puts one through many more embryo transfers and PIO shots and painful 2wws than oone actually may have needed. You could also end up wasting valuable time in trying to find that good embryo among the bad ones. Sometimes, when you are trying to find the one good embryo among a slew of frozen embies, it could take years!


3)Day 3 transfers instead of day 5 transfers: With the improvements in embryo culture, one thing is definitive: the womb offers no advantage over the petri dish. If a embryo can't make it in the petri dish from day 3 to day 5, its not going to do so in the uterus either. This is understandably a really tough pill to swallow, so many people chose not it to swallow it at all. Nobody wants to end up on day 5 with nothing to transfer, so they would rather prolong the receiving of the possibly negative verdict, by paying for a transfer (or do you pay the flat IVF rate), those godawful PIO shots, and the hell of a 2ww. Doctors also perpetuate this when they should be doling out tough love and waiting till day 5. Much respect for the clinics who only do Day 5 transfers.


4) Progesterone supplementation without checking if you need it. First, if you having a FET done, please insist on doing it during your natural cycle, instead of the down regulation + administered progesterone combination. What is the SENSE in this if you have a normal luteal phase? Why not just wait till ovulation, when your body starts to make progesterone naturally? The only time this would be necessary is if you have luteal phase defect, or are undergoing a surrogate cycle (you sure as hell don't want them ovulating).

This brings me to my second point: progesterone supplementation. Doctors just assume you will need progesterone in assisted reproduction. How many people have had their natural progesterone checked? If you make enough naturally, you don't need the PIO shots or the suppositories. Women the world over can provide luteal support naturally. So can many infertile women! But they are still made to suffer through the pain of a PIO shot, just because their doctor cannot be bothered to order a blood test and check.

I've expressed a lot of strong opinions here, and it may offend some people. But this is all coming from a place of trying to make things easier while undergoing these treatments. Many times, you don't need 500 injections to get you pregnant, you just need 50 or so of them. But you still get 500 injections, because no medical professional can be bothered, and everybody just follows standardized protocols without asking...why am I doing this? Is this necessary? Is there an easier way?

IVF#2. The final tally

The results of this round have, frankly, been miraculous-looking. Whether they are actually miraculous (i.e., can produce a drooling, pooping bundle of joy still remains very much a question).

But here we go:

19 eggs, 15 mature, 16 fertilized.
Day 3: 9 eight-celled grade As, 1 five-celled Grade A,  2 six-celled grade Cs. (Plus 1 four-celled and 1 two-celled)
Day 4: 5 embryos are early blasts (!!), 2 reach the morula stage,  2 ten-celled, 4 eight-celled, 1-5-celled (grades AC-CC)
Day 5: 10 blasts!
Five 4AAs, one 3AA, one 2AA, one 1AA, and 2 early blasts (will get the final grade today, when they freeze these last 2 on day 6)

One source says that 40% of "good-looking"embryos make it to blast; Another source says that around 33% of all fertilized eggs make it to the blastocyst stage.

Either way, the results of this cycle are well above average. Last time, the issue was that I had very few mature eggs, but my blastocyst generation rate, from all fertilized eggs, was around 33%, which is dead average.

So why was it so good this time when it was so crappy last time?

More on that later, but this is definately one of those celebrate-becuase-you-bloody-well-can moments. You never know when things will change.

Oh, and I lost my old surrogate and found a new one in the space of 2 hours. And I was lucky enough to find somebody whose cycle began 2 days ago- so a transfer is imminent. More on surrogacy in India soon- have to say, it's SUCH a different set of rules.

More on all of this later, this post has been typed from my phone, so please excuse any typos.

But for now---wheeeeeeeee!!